AB1229 COMPARISON OF FRACTURE RISK BY FRAX WITH AND WITHOUT BONE MINERAL DENSITY IN PATIENTS WITH RHEUMATIC DISEASES
Authors: A. Carrazco Chapa, K. M. López Serna, O. E. Alvarez-González, K. A. Mendieta Pedraza, M. C. Martínez Rodríguez, J. Medina Castillo, C. M. Skinner Taylor, J. C. Riega-Torres, R. Negrete Lopez, D. Á. Galarza-Delgado
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> FRAX is a well-validated instrument that calculates the probability of a major osteoporotic fracture over the following 10 years based on a set of risk factors such as age, body mass index (BMI), history of fragility fracture, steroid treatments used in patients with autoimmune rheumatic diseases (ARD) such as rheumatoid arthritis (RA), and secondary osteoporosis [1]. The FRAX score obtained without bone mineral density (BMD) is comparable to the fracture risk calculated using BMD values; it aims to identify patients who are likely to benefit from health interventions [2]. <h3>Objectives</h3> To compare the fracture risk using FRAX with and without BMD in patients with ARD. <h3>Methods</h3> An observational, cross-sectional, prospective study was carried out at the Rheumatology Clinic in the University Hospital "Dr. José Eleuterio González" in Monterrey, Mexico from September to December 2022. We included &gt; 40 years old ARD patients with a previous BMD test who were evaluated as part of a "Bone Health Program". The risk fracture scores were compared using FRAX with and without BMD. There were classified as low (&lt;10% probability of a major fracture), intermediate (10% - 19% probability) and high risk (≥20% probability). Non-traditional risk factors such as visual problems, periodontal disease, 2 or more falls in the last year, lack of physical activity, the ARD diagnosis or the consumption of disease-modifying drugs (DMARDs), were collected using a semi-structured form. The Kolmogorov-Smirnov test was used to determine normality. Data were presented as percent frequency, mean ± standard deviation (SD), or median and interquartile range (IQR) as appropriate. We used the Mann–Whitney U or Chi-square to analyze the differences between groups. A p&lt;0.05 was considered statistically significant. The statistical analysis was performed with SPSS v.25. <h3>Results</h3> A total of 146 patients were included: 142 (97.3%) were women and 4 (2.7%) were men with a mean age of 61.49 ± 9.22. The most frequent BMI was overweight (43.2%), followed by normal (31.5%), obesity grade 1 (13.7%), obesity grade 2 (10.3%) and obesity grade 3 (1.4%). The occupations were housewife (78.8%), employed (17.1%) and owned business (4.1%). The most prevalent main diagnosis was RA (45.9%) followed by osteoporosis (24.7%), osteoarthritis (14.4%), systemic lupus erythematosus (3.4%), Sjogren's syndrome (2.7%) and others (8.9%). The risk factors used by FRAX can be found in <b>Figure 1.</b> According to the non-traditional risk factors, 24.7% suffered 2 or more falls in the last year, 26% had periodontal disease, 71.9% were sedentary and 53.8% had visual problems. The median T-score spine was -1.7 [IQR (-2.5) - (-0.8)] and the mean T-score hip was -1.06 ± 1.21. The risk fracture scores using FRAX with and without BMD are in <b>Table 1</b>. <h3>Conclusion</h3> Higher hip fracture and major fracture risks were identified in the FRAX without BMD group. We found significant differences between the hip fracture risk of FRAX with and without BMD. Nevertheless, no differences were found in the major fracture risk of FRAX with and without BMD; this is of critical importance if all patients cannot have their BMD measured. The FRAX use makes it possible to offer a larger population a timely diagnosis. <h3>References</h3> [1]Carranza-Lira S, Lanuza-López MC, Sandoval Barragán MP. Comparación del riesgo de fractura calculado con la herramienta FRAX con y sin densitometría ósea en un grupo de mujeres mexicanas. Ginecol Obstet Mex 2014; 82:591-594. [2]Kanis JA, McCloskey E, Johansson H, Oden A, Leslie WD. FRAX (®) with and without bone mineral density. Calcif Tissue Int. 2012;90(1):1-13. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.